Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The impact of parenteral nutrition on the body composition of patients with acute pancreatitis

Background: Nutrition support by the enteral route is now the preferred modality in patients with severe acute pancreatitis. Parenteral nutrition is now required to supplement enteral nutrition when the latter is not able to provide the full nutritional requirement. We report the changes in body composition, plasma proteins, and resting energy expenditure (REE) during 14 days of parenteral nutrition (PN) in patients with acute pancreatitis. Methods: Total body protein (TBP), total body water (TBW), and total body fat (TBF) were measured by neutron activation analysis and tritium dilution before and after PN. Fat-free mass (FFM) was derived as the difference between body weight and TBF. REE was measured by indirect calorimetry. Protein index (PI) was the ratio of measured TBP to TBP, calculated from healthy volunteers. Results: Fifteen patients with acute pancreatitis (11 men, 4 women; median age 56, range 30-80 years) were studied. Thirteen patients had severe acute pancreatitis (Atlanta criteria), and 1 patient died. The gains in body weight (1.05 +/- 0. 77 kg), TBW (0.49 +/- 0.87 kg), TBP (0.20 +/- 0.22 kg), FFM (0.73 +/- 0.92 kg), TBF (0.32 +/- 0.95 kg), and REE (146 +/- 90 kcal/d) after 14 days of PN were not significant. Plasma prealbumin increased by 46.5% (p = .020). When patients (n = 6) with intercurrent sepsis and recent surgery were excluded, there were significant increases in TBP (0.65 +/- 0.17 kg, p = .005) and PI (0.060 +/- 0.011, P = .0006). Conclusions: Body composition is preserved in acute pancreatitis during 14 days of PN. In patients without sepsis or recent surgery, PN is able to significantly increase body protein stores

Characterisation of the small RNAs in the biomedically important green-bottle blowfly Lucilia sericata

10.1371/journal.pone.0122203PLoS ONE103e012220